Benefit of Warfarin Compared With Aspirin in Patients With Heart Failure in Sinus Rhythm A Subgroup Analysis of WARCEF, a Randomized Controlled Trial

作者：Homma Shunichi^*; Thompson John L P; Sanford Alexandra R; Mann Douglas L; Sacco Ralph L; Levin Bruce; Pullicino Patrick M; Freudenberger Ronald S; Teerlink John R; Graham Susan; Mohr J P; Massie Barry M; Labovitz Arthur J; Di Tullio Marco R; Gabriel Andre P; Lip Gregory Y H; Estol Conrado J; Lok Dirk J; Ponikowski Piotr; Anker Stefan D

来源：Circulation-Heart Failure, 2013, 6(5): 988-997.

DOI：10.1161/CIRCHEARTFAILURE.113.000372

• aspirin
• heart failure
• sinus rhythm
• stroke
• warfarin

Background The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome between warfarin and aspirin in 2305 patients with reduced left ventricular ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin. %26lt;br%26gt;Methods and Results We used a Cox model stepwise selection procedure to identify subgroups that may benefit from warfarin or aspirin on the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age group was a significant treatment effect modifier (P for interaction, 0.003). Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09; 95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added, in younger patients the event rate remained lower for warfarin than aspirin (5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P=0.005), but in older patients it became significantly higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio, 1.25; 95% confidence interval, 1.02-1.53; P=0.03). %26lt;br%26gt;Conclusions In patients %26lt;60 years, warfarin improved outcomes over aspirin with or without inclusion of major hemorrhage. In patients 60 years, there was no treatment difference, but the aspirin group had significantly better outcomes when major hemorrhage was included. %26lt;br%26gt;Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041938.

• 出版日期2013-9
• 单位河北医科大学